LGD OF PINAWA – ORDER FORM Shaw Direct is Pinawa’s Provider for Shaw) Direct Digital Satellite Television 100% Digital Satellite TV Please remit completed form to: LGD of Pinawa, Box 100, Pinawa, MB R0E 1L0 Or return in person to the Municipal Office ❑ I wish to sign up for Shaw Direct effective ________________________________________ ❑ I wish to cancel my Shaw Direct effective ________________________________________ * You will be billed for the month in which your Shaw Direct was cancelled * I understand if I wish to sign up for Shaw Direct Satellite TV, I will need to wait 1 year from date of cancellation. Essential Information First Name Street Address Surname Mailing Address Phone Number City/Province Pinawa, Manitoba Alt Phone Number Postal Code R0E 1L0 Email Address I own this property ❑ I do not own this property ❑ Your Programming Your Hardware English Essentials $0 (included) Satellite Dish and Basic Installation $0 (included) Pinawa Selected Bundles $0 (included) DSR 800 – Essential Receiver $0 (included) (Real Life, Lifestyle, Sports, Primetime, Timeshift)) Upgrade to an Advanced HD PVR830 $199.99 ❑ Crave + HBO + Movies $20.00 ❑ Additional Hardware * ** Cost Quantity Super Channels $10.00 ❑ HD DSR 800 Essential Receiver $149.99 each ❑ Hollywood Suite $7.00 ❑ Advanced HDPVR630 $299.99 each ❑ STARZ $10.00 ❑ ND Additional Bundles $8.00 ❑ 2 Receiver Discount $50.00 ❑ Subsequent receiver(s) regular price Pick and Pay any 10 Channels $24.00 ❑ *$50 installation fee for any lines needed for additional receivers. Please review the following link for bundle options: ** If your account has 2 or more receivers there will be an http://www.shawdirect.ca/english/packages/programming/bundles additional monthly Multi-Receiver charge of $5.99. First six (6) months are no charge. Signature Date OFFICE USE ONLY Remitted to Shaw Direct via Email _______________________________________________ Invoice / Refund Provided __________________________________________________________ .